scholarly journals Acute kidney injury in patients with chronic heart failure

2021 ◽  
Vol 2 (3) ◽  
pp. 6-17
Author(s):  
A. G. Arutyunov ◽  
R. A. Bashkinov ◽  
T. I. Batluk ◽  
E. S. Melnikov ◽  
A. N. Ermilova
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Chronic Heart Failure ◽  
Negative Impact ◽  
Kidney Injury ◽  
Cardiorenal Syndrome ◽  
Pathological Process ◽  
Reduced Ejection Fraction ◽  
Coronavirus Infection

The problem of chronic heart failure (CHF) and especially CHF with reduced ejection fraction is one of the most significant for modern healthcare systems. This is due to the high mortality rate, reduced quality of life, frequent hospitalizations and marked comorbidity of patients with this pathology. Involvement of the kidneys in the pathological process is one of the most common comorbid conditions in cardiovascular disease. There are a large number of pathogenetic mechanisms of mutually negative impact of heart failure and renal dysfunction, reflected in the concept of «Cardiorenal syndrome». Moreover, drug therapy of CHF can be one of the causes of kidney damage. Episodes of acute circulatory decompensation as well as a new coronavirus infection (COVID-19) are particularly threatening conditions. The aim of this review is to consolidate the international literature on the problem of acute kidney injury in patients with CHF.

scholarly journals CARDIORENAL SYNDROME IN PATIENTS WITH CHRONIC HEART FAILURE AS A STAGE OF THE CARDIORENAL CONTINUUM (PART I): DEFINITION, CLASSIFICATION, PATHOGENESIS, DIAGNOSIS, EPIDEMIOLOGY

2019 ◽  
Vol 9 (1) ◽  
pp. 5-22 ◽  
Author(s):  
E. V. Reznik ◽  
I. G. Nikitin
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Chronic Heart Failure ◽  
Impaired Renal Function ◽  
Prognostic Value ◽  
Kidney Injury ◽  
Cardiorenal Syndrome ◽  
Syndrome Type ◽  
Patients With Heart Failure

The combination of heart failure and renal failure is called cardiorenal syndrome. It is a stage of the cardiorenal continuum and, possibly, a small link of the cardiorenal-cerebral-metabolic axis. Despite the fact that the phrase “cardiorenal syndrome” and its five types have become a part of the medical lexicon, many aspects of this problem are still not clear. Cardiorenal syndrome can be diagnosed in 32-90.3% of patients with heart failure. Cardiorenal syndrome type 1 or 2 develops in most cases of heart failure: cardiorenal syndrome presents with the development ofchronic kidney disease in patients with chronic heart failure and acute kidney injury in patients with acute heart failure. Impaired renal function has an unfavorable prognostic value. It leads to an increase in the mortality of patients with heart failure. It is necessary to timely diagnose the presence of cardiorenal syndrome and take into account its presence when managing patients with heart failure. Further researches are needed on ways toprevent the development and prevent the progression of kidney damage in patients with heart failure, to which the efforts of the multidisciplinary team should be directed. The first part of this review examines the currently definition, classification, pathogenesis, epidemiology and prognosis of cardiorenal syndrome in patients with heart failure.

Clinical Significance of Acute Kidney Injury in Patients Admitted for Worsening Chronic Heart Failure

2011 ◽  
Vol 17 (9) ◽  
pp. S163
Author(s):  
Shigeru Matsui ◽  
Junnichi Ishii ◽  
Kousuke Hattori ◽  
Tousei Hashimoto ◽  
Hiroyuki Naruse ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Chronic Heart Failure ◽  
Clinical Significance ◽  
Kidney Injury

Acute kidney injury in heart failure

2015 ◽  
Author(s):  
Dinna N. Cruz ◽  
Anna Giuliani ◽  
Claudio Ronco
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Volume Overload ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Cardiorenal Syndrome ◽  
Renal Diseases ◽  
Consensus Definition ◽  
Short And Long Term

Acute kidney injury (AKI) occurring during heart failure (HF) has been labelled cardiorenal syndrome (CRS) type 1. CRS is defined as a group of ‘disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other’. This consensus definition was proposed by the Acute Dialysis Quality Initiative, with the aim to standardize those disorders where cardiac and renal diseases coexist. Five subtypes have been proposed, according to which organ is affected first (cardiac vs renal) and whether the dysfunction is acute or chronic. Another subtype which includes systemic conditions leading to both heart and kidney dysfunction is also described.The term ‘worsening renal function’ has been regularly used to describe the acute and/or subacute changes that occur in the kidneys following HF. However, the AKI classification according to the current consensus definition better represents the entire spectrum of AKI in the setting of HF.The pathophysiology of heart–kidney interaction is complex and still poorly understood. Factors beyond the classic haemodynamic mechanisms appear to be involved: neurohormonal activation, venous congestion, and inflammation have all been implicated.Diuretics are still a cornerstone in the management of HF. Intravenous administration by bolus or continuous infusion appears to be equally efficacious. Biomarkers and bioelectrical impedance analysis can be helpful in estimating the real volume overload and may be useful to predict and avoid AKI. The role of ultrafiltration remains controversial, and it is currently recommended only for diuretic-resistant patients as it has not been associated with better outcomes. The occurrence of AKI during HF is associated with substantially greater short- and long-term mortality.

scholarly journals One-Year Survival and Renal Function Recovery of Acute Kidney Injury Patients with Chronic Heart Failure

2014 ◽  
Vol 5 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Wen Zhang ◽  
Dan Wen ◽  
Yan-Fang Zou ◽  
Ping-Yan Shen ◽  
Yao-Wen Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Acute Kidney Injury ◽  
Chronic Heart Failure ◽  
Clinical Characteristics ◽  
Nyha Class ◽  
Kidney Injury ◽  
Class Iii ◽  
Kidney Dysfunction ◽  
Nyha Classification

Objective: To describe and analyze the clinical characteristics of acute kidney injury (AKI) patients with preexisting chronic heart failure (CHF) and to identify the prognostic factors of the 1-year outcome. Methods: A total of 120 patients with preexisting CHF who developed AKI between January 2005 and December 2010 were enrolled. CHF was diagnosed according to the European Society of Cardiology guidelines, and AKI was diagnosed using the RIFLE criteria. Clinical characteristics were recorded, and nonrecovery from kidney dysfunction as well as mortality were analyzed. Results: The median age of the patients was 70 years, and 58.33% were male. 60% of the patients had an advanced AKI stage (‘failure') and 90% were classified as NYHA class III/IV. The 1-year mortality rate was 35%. 25.83% of the patients progressed to end-stage renal disease after 1 year. Hypertension, anemia, coronary atherosclerotic heart disease and chronic kidney disease were common comorbidities. Multiple organ dysfunction syndrome (MODS; OR, 35.950; 95% CI, 4.972-259.952), arrhythmia (OR, 13.461; 95% CI, 2.379-76.161), anemia (OR, 6.176; 95% CI, 1.172-32.544) and RIFLE category (OR, 5.353; 95% CI, 1.436-19.952) were identified as risk factors of 1-year mortality. For 1-year nonrecovery from kidney dysfunction, MODS (OR, 8.884; 95% CI, 2.535-31.135) and acute heart failure (OR, 3.281; 95% CI, 1.026-10.491) were independent risk factors. Conclusion: AKI patients with preexisting CHF were mainly elderly patients who had an advanced AKI stage and NYHA classification. Their 1-year mortality and nonrecovery from kidney dysfunction rates were high. Identifying risk factors may help to improve their outcome.

scholarly journals Value of Plasma NGAL and Creatinine on First Day of Admission in the Diagnosis of Cardiorenal Syndrome Type 1

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Hao Phan Thai ◽  
Bao Hoang Bui ◽  
Tien Hoang Anh ◽  
Minh Huynh Van
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Predictive Value ◽  
Kidney Injury ◽  
Cardiorenal Syndrome ◽  
Admission Diagnosis ◽  
Multivariable Logistic Regression Analysis ◽  
Plasma Ngal ◽  
Model Average ◽  
Study Results

Background. The presence of acute kidney injury in the setting of acute heart failure (AHF) or acute decompensated heart failure (ADHF) is a very common occurrence and was termed cardiorenal syndrome 1 (CRS1). Neutrophil gelatinase-associated lipocalin (NGAL) in the blood and urine is one of the earliest biomarkers of acute kidney injury due to ischemia or renal toxicity. This study was aimed to evaluate the diagnostic efficacy of plasma NGAL in the diagnosis of CRS1. Methods. There were 139 patients with AHF or ADHF in the department of Cardiovascular Resuscitation and Interventional Cardiology at Ho Chi Minh City 115 People Hospital from September 2018 to March 2019. This was a prospective cohort study. Results. There were 48 cases (rate 34.5%) with CRS1, mean age was 66.12 ± 15.77 and men accounted for 50.4%. There were no significant differences of vital signs at admission, diagnosis, and EF-based heart failure between CRS1 and non-CRS1 groups. The urea, creatinine on first day (creatinine D1) and third day (creatinine D3), NT-proBNP, and NGAL levels were higher in the CRS1 group than the non-CRS1 group, p < 0.05 . The optimal cutoff plasma NGAL for diagnosing CRS1 was >353.23 ng/ml, area under curve (AUC) 0.732 (95% CI 0.65–0.80, p < 0.001 ), sensitivity 74.47%, specificity 68.48%, positive predictive value 54.7%, and negative predictive value 84%. Multivariable logistic regression analysis eGFRCKDEPID1 remained the strongest independent predictor of CRS1. Building the optimal regression model (without eGFRCKDEPID1) by the BMA (Bayesian model average) method with two variables NGAL and Creatinine D1, we had the equation: odds ratio = ey while y = −2.39 + 0.0037 × NGAL + 0.17 × Creatinine D1. The nomogram (without eGFRCKDEPID1) was designed to predict the likelihood of CRS1 with AUC 0.79. Conclusions. The combination of plasma NGAL and creatinine D1 on the first day at admission had a high accuracy of predictive model for CRS1.

MANIFESTATIONS OF HEART INSUFFICIENCY IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL INFARCTION COMPLICATED WITH ACUTE KIDNEY DAMAGE

2021 ◽  
pp. 120-127
Author(s):  
Golikov A.V. ◽  
Reiza V.A. ◽  
Tassybayev B.B. ◽  
Gordienko A.V.
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Kidney Injury ◽  
Chronic Heart Failure ◽  
Absolute Risk ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Winter Period ◽  
Study Group ◽  
Type I

Relevance. Acute kidney injury in myocardial infarction worsens its prognosis, including due to the development of chronic heart failure. Moreover, most of the data was obtained for patients over 60 years old. Aim. To evaluate the features of the heart failure manifestations in men under 60 years old with myocardial infarction complicated by acute kidney injury to improve prevention and outcomes. Material and methods. The study included men 19-60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I - study group, with acute kidney injury - 25 patients; II - control, without it - 486 patients. A comparative analysis of the heart failure main manifestations frequency in the first 48 hours (1) and at the end of the third week of the disease (2), their dynamics, analysis of their impact on the risk of chronic heart failure development in acute kidney injury (ANOVA) was performed. Results. The study group (4.0%) differed from the control (21.8%) in a lower frequency of acrocyanosis (p = 0.03) and liver enlargement (8.0 and 25.7%; respectively; p = 0.046) at the end of the eighth week diseases. The main risk markers of the chronic heart failure development in study group were: winter period of the year (absolute risk: 94.1%; relative - 3.76; p = 0.0003), respiratory infections 2-3 times a year (absolute risk: 81.8%; p = 0.003), left ventricular myocardial mass index1 ≥ 173.3 g/m2 (absolute risk: 100%; p = 0.008) and mean arterial pressure1 ≥ 120 mm Hg (absolute risk: 100%; relative - 1.88; p = 0.01). Conclusions. Men under 60 years old with acute kidney injury in myocardial infarction are characterized by a higher incidence of chronic heart failure. The listed above values of the different predictors should be used in the formation of the high-risk groups for the chronic heart failure in acute kidney injury development, as well as for prognostic modeling.

scholarly journals Markers of renal function and acute kidney injury in acute heart failure: definitions and impact on outcomes of the cardiorenal syndrome

2010 ◽  
Vol 31 (22) ◽  
pp. 2791-2798 ◽  
Author(s):  
J. P. E. Lassus ◽  
M. S. Nieminen ◽  
K. Peuhkurinen ◽  
K. Pulkki ◽  
K. Siirila-Waris ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Acute Heart Failure ◽  
Kidney Injury ◽  
Cardiorenal Syndrome

scholarly journals Vagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Lucas Bonacossa Sant'Anna ◽  
Sérgio Lívio Menezes Couceiro ◽  
Eduardo Amar Ferreira ◽  
Mariana Bonacossa Sant'Anna ◽  
Pedro Rey Cardoso ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Systematic Review ◽  
Chronic Heart Failure ◽  
Meta Analysis ◽  
Functional Class ◽  
Walk Test ◽  
Reduced Ejection Fraction ◽  
Nyha Functional Class

Objectives: The aim of this study was to evaluate the effects of invasive vagal nerve stimulation (VNS) in patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF).Background: Heart failure is characterized by autonomic nervous system imbalance and electrical events that can lead to sudden death. The effects of parasympathetic (vagal) stimulation in patients with HF are not well-established.Methods: From May 1994 to July 2020, a systematic review was performed using PubMed, Embase, and Cochrane Library for clinical trials, comparing VNS with medical therapy for the management of chronic HFrEF (EF ≤ 40%). A meta-analysis of several outcomes and adverse effects was completed, and GRADE was used to assess the level of evidence.Results: Four randomized controlled trials (RCT) and three prospective studies, totalizing 1,263 patients were identified; 756 treated with VNS and 507 with medical therapy. RCT data were included in the meta-analysis (fixed-effect distribution). Adverse effects related to VNS were observed in only 11% of patients. VNS was associated with significant improvement (GRADE = High) in the New York Heart Association (NYHA) functional class (OR, 2.72, 95% CI: 2.07–3.57, p &lt; 0.0001), quality of life (MD −14.18, 95% CI: −18.09 to −10.28, p &lt; 0.0001), a 6-min walk test (MD, 55.46, 95% CI: 39.11–71.81, p &lt; 0.0001) and NT-proBNP levels (MD −144.25, 95% CI: −238.31 to −50.18, p = 0.003). There was no difference in mortality (OR, 1.24; 95% CI: 0.82–1.89, p = 0.43).Conclusions: A high grade of evidence demonstrated that vagal nerve stimulation improves NYHA functional class, a 6-min walk test, quality of life, and NT-proBNP levels in patients with chronic HFrEF, with no differences in mortality.

CORONARY ARTERIES STATE IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL INFARCTION, COMPLICATED WITH ACUTE KIDNEY INJURY

2021 ◽  
pp. 98-105
Author(s):  
Nosovich D.V. ◽  
Epifanov S.Yu. ◽  
Tassybayev B.B.
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Kidney Injury ◽  
Chronic Heart Failure ◽  
Coronary Arteries ◽  
Absolute Risk ◽  
Kidney Injury ◽  
Study Group ◽  
Type I ◽  
General Group

Relevance. The role of the coronary arteries angiographic changes severity in myocardial infarction complicated by acute kidney injury is assessed in different ways. Aim. To evaluate the features of the coronary arteries state in men under 60 years old with myocardial infarction complicated by acute kidney injury to improve prevention and outcomes. Material and methods. The study included men 19-60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I - study group, with acute kidney injury - 25 patients; II - control, without it - 168 patients. A comparative assessment of coronary angiography indicators, also acute kidney injury and heart failure development risk analysis (ANOVA) were performed. Results. There were no differences in the compared groups in angiographic data, localization, depth of the lesion, and the frequency of the complicated course of the disease. The study group were characterized by akinesia in the middle anterior (in the studied% 100; control: 15.6%; p =0.02) and antero-septal (100 and 17.7%; respectively; p=0.04) segments , as well as the frequency of registration of chronic heart failure (72.0 and 43.2%; p=0.005) by the eighth week of myocardial infarction. Bypass surgery (absolute risk: 46.2%; relative - 4.37; p=0.0002) and unstable angina (absolute risk: 19.8%; relative - 2,46; p=0.02) in the medical history, as well as the presence of peripheral angiopathies (absolute risk: 18.9%; relative - 3.21; p=0.0008). Conclusions. Men under 60 years old with acute kidney injury in myocardial infarction were not differ in the number and extent of large coronary artery lesions from the general group. They are characterized by large in area and severity of dysfunction lesions of the anterior middle segments of the left ventricle with a higher frequency of chronic heart failure than in the general group. The anamnestic data listed above associated with coronary arteries is advisable to use in the formation of groups at high risk for the acute kidney injury development formation, as well as prognostic modeling.

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